ISM Western New England
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ism ISM-Western New England
P.O. Box 924
Springfield, MA 01101
 
http://www.ismwne.com/
e-mail:
ismismwne@ismwne.com

New, Renewal & Transfer Membership 2016 Form

I wish to become an ISM member through ISM Western New England

Please complete required fields "*".

First Name:

*

Last Name:

*

Home phone:

Home e-mail:

2nd Name:

2nd Home e-mail:

3rd Name:

3rd Home e-mail:

4th Name:

4th Home e-mail:

5th Name:

5th Home e-mail:

6th Name:

6th Home e-mail:

7th Name:

7th Home e-mail:

8th Name:

8th Home e-mail:

9th Name:

9th Home e-mail:

10th Name:

10th Home e-mail:

Please complete the following if information has changed

Name:

Title:

Professional Designations:

Company Name:

Mailing Address:

Address:
City:
State:

Zip:

Phone Number:

Fax Number:

 

E-Mail:

*
The following are questions for membership transfers

Affiliate Name:

Affiliate Code:

Replacing Member:

Company:

City State Zip:

Transfer Name:

Transfer Title:

Transfer Professional Designations:

Transfer Company Name:

Transfer Mailing Address:

Transfer City State Zip:

Transfer Phone Number:

Transfer Fax Number:

Transfer E-mail:

Transfer Home E-mail:

The following are questions for new membership

New Name:

New Company:

New City State Zip:

New Title:

New Professional Designations:

New Company Name:

New Mailing Address:

New City State Zip:

New Phone Number:

New Fax Number:

New E-mail:

New Home E-mail:

2nd New Name:

2nd New Company:

2nd New City State Zip:

2nd New Title:

2nd New Professional Designations:

2nd New Company Name:

2nd New Mailing Address:

2nd New City State Zip:

2nd New Phone Number:

2nd New Fax Number:

2nd New E-mail:

2nd New Home E-mail:

Payment Type

*
PAYMENT BY CHECK - Payable to: ISMWNE - Mail to P.O.: Box 924, Springfield, MA 01101

Other Information:


I agree to abide by ISM Bylaws, Principles and Standards of Purchasing Practice, and Statement of Antitrust Policy. A copy of the ISM Bylaws may be obtained by calling ISM Customer Service at 1 800- 888- 6276.

Signature:

Date:

 

Printable Page Membership Application


ISM-Western New England,
P.0. BOX 924 SPRINGFIELD, MA 01101.
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